急性后间壁心肌梗死心电图诊断标准商榷  

Discussion of electrocardiographic diagnostic criteria for acute posteroseptal myocardial infarction

作　　者：陈纪林[1] 陈在嘉[1] 袁晋青[1] 田月琴[2] 乔树宾[1] 史蓉芳[2] 唐熠达[1] 杨跃进[1] 陆宗良[1] 高润霖[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院冠心病研究室,北京100037 [2]中国医学科学院中国协和医科大学阜外心血管病医院核医学科,北京100037

出　　处：《中华心血管病杂志》2003年第5期346-348,共3页Chinese Journal of Cardiology

摘　　要：目的　对 4例下壁急性心肌梗死 (AMI)伴V1 3 和V3R 5R导联ST段抬高入院诊断为下壁、右室合并前间壁AMI的梗死部位进行探讨 ,藉以商榷急性后间壁心肌梗死诊断标准。方法　根据心电图及核素心肌灌注显像和冠状动脉造影资料进行分析。结果　 4例患者心电图表现为Ⅱ、Ⅲ、aVF、V1 3 和V3R 5RST段抬高 ,其中V1导联ST段抬高最显著 ,放射性核素99mTc MIBI心肌灌注缺损部位在下壁和后间壁 ,4例患者梗死相关动脉均为右冠状动脉。结论　根据以上发现我们提出后间壁AMI的心电图诊断标准如下 :①下壁AMI同时伴V1导联ST段明显抬高≥ 2mm ;②ST段抬高的幅度呈V1>V2 >V3 和V1>V3R>V4R,同时具备以上两个条件即可诊断为下壁、后间壁AMI。Objective To approach the infarct sites in 4 patients with inferior wall AMI concomitant ST segment elevation in leads V_ 1-3 and V_ 3R-5R . These patients were diagnosed as inferior, right ventricular and anteroseptal walls AMI at admission. Methods Electrocardiographic data and results of isotope 99m Tc-MIBI myocardial perfusion imaging and coronary angiography were analyzed.Results Electrocardiogram showed ST segment significantly elevated in standard leads Ⅱ,Ⅲ , aVF, and leads V_ 1-3 and V_ 3R-5R , the magnitude of ST segment elevation was maximal in lead V_1. There was isotope 99m TC-MIBI myocardial perfusion defect in inferior and posteroseptal walls in these patients. Coronary angiography showed that right coronary artery was infarct-related artery. Conclusion According to data above, we put forward the diagnostic criteria for the posteroseptal wall AMI as followed: ① ST segment elevation ≥2mm in lead V_1 in the clinical setting of inferior wall AMI. ② The magnitude of ST segment elevation in leads V_ 1-3 and leads V_ 3R-5R are showed as V_1>V_2>V_3 and V_1>V_ 3R >V_ 4R .With two conditions above, inferior and posteroseptal walls AMI should be diagnosed.

关 键 词：急性后间壁心肌梗死 心电图 诊断 核素心肌灌注显像 冠状动脉造影 

分 类 号：R542.22[医药卫生—心血管疾病] R540.41[医药卫生—内科学]